Provider Demographics
NPI:1164038584
Name:ROE, TYSON (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:
Last Name:ROE
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 US HIGHWAY 93 S STE D
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-5776
Mailing Address - Country:US
Mailing Address - Phone:406-314-6565
Mailing Address - Fax:406-314-6566
Practice Address - Street 1:1645 US HIGHWAY 93 S STE D
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5776
Practice Address - Country:US
Practice Address - Phone:406-314-6565
Practice Address - Fax:406-314-6566
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT83795101YS0200X
MTBBH-LCPC-LIC-57420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty